Health Inequalities: Supporting Deaf People

I am delighted to bring to you an article by Carly Renaud (she/her), who works as a Quality Improvement Officer in the South West region of NHS England and Improvement. Carly shares her experiences of working as a British Sign Language Interpreter and supporting Deaf people in very important and sensitive periods of their life. Exploring the health inequalities experienced by the Deaf community, Carly explores what leaders in the NHS can do improve access for the Deaf community. ‘Support for supporters’ is also a crucial topic to explore. I was intrigued to learn how Carly maintained her own support structure by attending supervision groups with other interpreters.

Foreword from Erk Gunce (pronouns: him/he/his)

Inclusion Coordinator, NHS South West Leadership Academy

Carly Renaud (pronouns: she/her)

Quality Improvement Officer, NHS England and NHS Improvement – South West

I joined NHSE/I back in September 2020. I’m originally from the Midlands but have lived in the South West since 2002. I love living down here and never take for granted being 15 minutes from the coast with all the fun that brings us as a family. I’m a Mom of 2 children (14 and 10). We enjoy spending time outside as a family with our dog and lots of competitive board game.  My husband is a serving member of the Royal Navy, which brings us lots of pride as a family but can cause extra pressure with extended time apart.

My previous professional experience was as a registered British Sign language (BSL) / English Interpreter. I worked as a community interpreter for over 16 years. My speciality of community work meant I worked in a wide variety of settings from medical, legal, employment, education, performing arts, conferences, weddings and funerals. The range of situations challenged me as an interpreter in so many ways, on the technical side there was the need to match the needs of the clients I was working with; this includes both the Hearing and Deaf clients.  It was crucial for the message to accurately represent the speaker in their tone, intention and formality while also ensuring that it is culturally appropriate and understood by the receiver. This has hopefully led to the development of many transferable skills around communication, not only in producing messages to a variety of audiences but also understanding the core meaning of a message and reading the dynamics and intention in a room.

As an interpreter, I always felt incredibly humbled to be involved in such sensitive and important moments in a Deaf person’s life; whether at the birth of their child, a pivotal job interview, a harrowing police interview, a medical emergency or a family funeral to name just a few. In my 16-year career, approximately 70% of my work was for the NHS, my work included the whole spectrum of cradle to grave, emergency to routine, acute to primary care and clinical and non-clinical. This has provided me with an extensive understanding of the NHS, more importantly it has given me a unique insight into the patient’s experience in these settings.

Unfortunately, my experience also highlighted the massive health inequalities that the Deaf community face. There is a vast amount of work that is still required to ensure that real inclusion occurs and that the needs of the Deaf community are met and that we fulfil our requirements under the Equality Act 2010 by making the appropriate reasonable adjustments.

A report in 2010, “Sick of It” by a leading Deaf charity reported the vast health inequalities that the Deaf community face. The study found poorer health, poorer diagnosis and poorer treatment/management, which were largely caused by poor access to services, poor communication, and poor access to information. Although this study looked at physical, rather than mental health, Deaf people reported more depression than the rest of the population (24% compared with 12%), in keeping with previous studies. A high proportion of people who had been diagnosed with a condition did not seem to have it under control. This was the case with Deaf people with hypertension, cardiovascular disease, diabetes and high cholesterol. This raises questions about whether the diagnosis has been properly conveyed, whether clinicians are monitoring it sufficiently, and whether Deaf people are given information in an accessible format.  Unfortunately, many of these health inequalities are still apparent now and the Covid pandemic in some cases has increased this gap and the barriers that Deaf people face.

There are some key changes that leaders and all staff within the NHS can make to improve access for the Deaf community. These are just the top 3 suggestions. Firstly, Deaf awareness training for all staff to ensure that staff are aware of the current barriers that Deaf people face and their communication needs. Secondly, ensuring that appropriate access is provided, suitable commissioning is in place and that this access provision is circulated to all staff to ensure that it is utilised. Ensuring access provisions such as registered trained interpreters are used in all settings will make a significant difference to the access, communication and the understanding of these important appointments. Finally, and most importantly, consult with the Deaf community, ensure that their views are incorporated in decision making around services provided and to ensure that communications and information is accessible to all, not just to those whose first language is English.

I was incredibly privileged in my career to have the availability of excellent and varied support which enabled me to not only develop my skills but to also ensure that I was psychologically safe and able to have a long career.

One key area of support was my regular facilitated supervision group. This group was led by a trained facilitator. Including myself, there were 3 qualified experienced interpreters in the session. We each raised different dilemmas or recent case studies, the facilitator supported our discussion of these to develop further coping strategies, see the assignment from different professional perspectives, identify training needs or where additional support may be available. The on-going nature of this support meant that we felt safe to share our experiences.

Another crucial part of my support package was the 1-1 supervision to develop my career path. These sessions not only supported my confidence, resilience and self-esteem but it also enabled me to identify my Professional Development Plan to be specific, targeted and achievable. It’s crucial for leaders to recognise that coaches, mentors or supervisors can learn a lot from structured support sessions.  As a trained Mentor, being a mentor was fulfilling as I could support others to develop their skills. Being a mentor also enhanced my own reflective practice. These sessions left me thinking more about the decisions I had made, the justification for these decisions and gave me valuable other perspective and options.

For further information, please visit the Association of Sign Language Interpreters, the National Registers of Communication Professionals working with Deaf and Deafblind People, the Reasonable Adjustments guide for disabled people and Research reports published by Signhealth, the Deaf Health Charity. If you wish to discuss these issues further, please feel free to get in touch directly with Carly.